title: High frequency distribution of heterogeneous vancomycin resistant Enterococcous faecium (VREfm) in Iranian hospitals.
abstract: BACKGROUND
  Enterococcus faecium is a multi-resistant nosocomial pathogen causing infection in debilitated patients. Vancomycin-resistant enterococcus faecium (VREfm) are a major concern and increased dramatically worldwide especially in hospitals environment. The current study focused on determining the high prevalence and distribution patterns of antibiotic resistance and also its genetic linkages among various VREfm strains isolated from indoor hospitalized patients in four major Iranian teaching hospitals of Tehran.
  
  
  METHODS
  The clinical samples were obtained from hospitalized patients during September 2010 to June 2011 from different teaching hospitals of Tehran. Antibiotics Resistance patterns, minimum inhibition concentration (MIC) value for vancomycin, ampicillin, gentamicin and presence of genetic linkage among the isolates were determined by pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  Overall, total of 92 (41.4%) isolates were identified as E. faecium, 45 (49%) were resistant to vancomycin with an MIC50 of ≥ 128 mg/L. The results showed that simultaneous resistance to teicoplanin, ampicillin, gentamicin, ciprofloxacine, tetracycline and erythromycin were observed the most frequent pattern. All the vancomycin resistant E. faecium isolates carried the vanA gene. intensive care units (ICUs) and Kidney transplantation, are most probably the wards with highest risk of infection by VRE. 17 pulsotypes were also detected by PFGE, most of the related pulsotypes belongs to the same hospitals.
  
  
  CONCLUSIONS
  This study shows the high alarming prevalence of Enterococcus faecium infection and similar clones of VREfm strains in Iranian hospitals with threatening resistance phenotypes.
  The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1270863903102282.
authors.affiliation: Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, P, O, Box: 14115-111, Tehran, Iran. mmmobarez@modares.ac.ir.
authors.forename: Leili
authors.initials: L
authors.lastname: Shokoohizadeh
authors.forename: Ashraf Mohabati
authors.initials: AM
authors.lastname: Mobarez
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Zali
authors.forename: Reza
authors.initials: R
authors.lastname: Ranjbar
authors.forename: Masoud
authors.initials: M
authors.lastname: Alebouyeh
authors.forename: Türkan
authors.initials: T
authors.lastname: Sakinc
authors.forename: Liaqat
authors.initials: L
authors.lastname: Ali
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D016984:Enterococcus faecium / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008040:Genetic Linkage; D005838:Genotype; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006757:Hospital Units; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D015995:Prevalence; D020713:Vancomycin Resistance / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents